Tie2 receptor activation for glaucoma

ABSTRACT

This invention relates to the production and genotyping of mice lacking both Angiopoietin 1 and Angiopoietin 2. This invention also relates to the use of Tie2 receptor activation for treatment of open angle glaucoma, congenital glaucoma and cystic kidney disease, and more specifically to the use of angiopoietin 1 recombinant proteins, peptides, VE-PTP phosphatase inhibitors, and Tie2-peptomimetics to improve lymphatic drainage in the Schlemm&#39;s canal and corneal limbal lymphatic system for open angle glaucoma and congenital glaucoma patients, and to slow and/or reduce the growth of cysts in patients with cystic kidney disease.

FIELD OF THE INVENTION

This invention relates to the use of Tie2 receptor activation fortreatment of open angle glaucoma, congenital glaucoma and cystic kidneydisease, and more specifically to the use of angiopoietin 1 recombinantproteins, peptides, VE-PTP phosphatase inhibitors, andTie2-peptomimetics to improve lymphatic drainage in the Schlemm's canaland corneal limbal lymphatic system for open angle glaucoma andcongenital glaucoma patients, and to slow and/or reduce the growth ofcysts in patients with cystic kidney disease.

BACKGROUND OF THE INVENTION

The Angiopoietin-Tie2 signaling pathway is a major regulator of vasculardevelopment, and altered expression of the Angiopoietin ligands oractivity of the Tie2 receptor has been linked to a variety of vasculardiseases and adverse outcomes in patients. In blood vascularendothelium, Angiopoietin2 is reported to function as a competitiveantagonist of Angiopietin1/Tie2 signaling, inhibitingAngiopoietin1-mediated phosphorylation of Tie2.

Pharmaceuticals with agents which inhibit or modify kinases andtherefore inhibit vascular development are used for treatment of sometypes of cancer as well as other diseases, such as neovascular glaucoma,abnormal ocular vasculatures and glaucoma generally as set out in U.S.Pat. Nos. 8,754,209, 8,529,943, 8,476,434, 8,450,305, 8,425,469, and8,338,455; and U.S. patent application Ser. Nos. 14/119,532, 13/920,103,14/131,024, and 13/652,154 (U.S. Patent Application Publication Nos.2014/0161720, 2014/0004175, 2014/0163079, and 2013/0095105,respectively), each of which is hereby incorporated by reference in itsentirety.

Knowledge of pathways regulating vascular development has been used todevelop drugs for controlling this development. Knowledge ofpathogenetic and molecular pathways leading to disease conditions canreveal methods of treating or preventing such conditions. For example,increased intraocular pressure (TOP) due to impaired aqueous humordrainage is a major risk factor for development of glaucoma, anddetermining the pathway by which this occurs would be helpful in findingother treatments. Glaucoma is a leading cause of blindness, afflictingmore than 60 million people worldwide.

Although inhibitory kinases haves been used to treat glaucoma,particularly neovascular glaucoma, there is a need to know the pathwaythat is active and leads to open angle glaucoma and congenital glaucomain order to provide better treatment and prevention of this condition.

SUMMARY OF THE INVENTION

Embodiments of the invention include a method of treating a patienthaving open angle glaucoma, congenital glaucoma or cystic kidney diseaseby administering a pharmaceutical composition comprising agents capableof TIE2 receptor activation. Embodiments of the invention include amethod of treating a patient having open angle glaucoma, congenitalglaucoma or cystic kidney disease comprising administering apharmaceutical composition comprising one or more of angiopoietin 1recombinant proteins, peptides, VE-PTP phosphatase inhibitors, andTie2-peptomimetics.

In embodiments, the invention includes the use of a pharmaceuticalcomposition comprising one or more of angiopoietin 1 recombinantproteins, peptides, VE-PTP phosphatase inhibitors and Tie2-peptomimeticsfor improving ocular lymphatic drainage. In embodiments, the inventionincludes the use of a pharmaceutical composition comprising one or moreof angiopoietin 1 recombinant proteins, peptides, VE-PTP phosphataseinhibitors and Tie2-peptomimetics for improving drainage throughSchlemm's canal and corneal limbal lymphatics.

In embodiments the invention is a pharmaceutical composition for topicaldelivery to the eye comprising an effective dosage amount of Tie2receptor activating agents. Embodiments of the invention include apharmaceutical composition comprising a pharmaceutically active amountof Tie2 receptor activating agents and a pharmaceutically acceptablecarrier for topical delivery to the eye. The pharmaceutically acceptablecarrier can be a controlled release vehicle, selected from the groupconsisting of biocompatible polymers, other polymeric matrices,capsules, microcapsules, nanocapsules, microparticles, nanoparticles,micro spheres, bolus preparations, osmotic pumps, diffusion devices,liposomes, lipospheres.

In embodiments, the invention is a conditional Angiopoeitin 2 knockoutallele. Embodiments of the invention also include the use of aconditional Angiopoeitin 2 knockout allele to produce mice lackingAngiopoeitin 2.

The invention also includes use of the following primers for PCRgenotyping of mice: Angpt1Flox, Forward 5′-CAATGCCAGAGGTTCTTGTGAA-3′;Reverse 5′-TCAAAGCAACATATCATGTGCA-3′ (WT: 233 bp product, Angpt1Flox:328 bp), Angpt1Delete, Forward 5′-CAATGCCAGAGGTTCTTGTGAA-3′; Reverse5′-TGTGAGCAAAACCCCTTTC-3′ (431 bp product), Angpt2Flox, Forward5′-GGGAAACCTCAACACTCCAA-3′; Reverse 5′-ACACCGGCCTCTAGACACAC-3′ (WT:224bp product, Angpt2Flox: 258 bp) and Angpt2Delete, Forward5′-AAGGCGCATAACGATACCAC-3′; and Reverse5′-TGAGAACTCTGCAGCCTTGA-3′(Angpt2Flox: 1,372 bp product, Angpt2Delete:426 bp).

The invention also includes a pharmaceutical composition forsubcutaneous delivery comprising an effective dosage amount of Tie2receptor activating agents for treatment of cystic kidney disease. Theinvention also includes a pharmaceutical composition comprising apharmaceutically active amount of Tie2 receptor activating agents and apharmaceutically acceptable carrier for subcutaneous delivery fortreatment of cystic kidney disease.

BRIEF DESCRIPTION OF THE FIGURES

These and other aspects of the present invention will be apparent fromthe brief description of the drawings and the following detaileddescription in which:

FIG. 1 shows A1A2Flox^(WBΔE16.5) (cKO) mice develop bilateralbuphthalmos. While control eyes (a,c,e,g) appear normal, 8-week oldA1A2Flox^(WBΔE16.5) mice (b,d,f,h) show enlargement of the anteriorchamber due to increased intraocular pressure (i). Optomotor responsetests (j) show impaired vision in mutant animals. Scale bars represent 1mm (e,f) and 500 μM (g,h). Error bars indicate s.e.m. *P<0.05,**P<0.01,***P<0.001 determined by two-tailed t test. NR (no response)indicates an optomotor response of <0.042 cycles/degree.

FIG. 2 shows slit lamp photography shows marked pupil dilation inA1A2Flox^(WBΔE16.5) mice (a) compared to a control littermate (b) at 8weeks of age. Pupil edge is indicated by arrows.

FIG. 3 shows A1A2Flox^(WBΔE16.5) mice develop glaucoma due to defects inocular drainage. Compared to controls (a), the optic nerve head appearsabnormal in A1A2Flox^(WBΔE16.5) mice (g), with thinning of the nervefiber layer (red arrowheads) and optic nerve excavation (asterisk).Semi-thin sections show thinning of the nerve fiber, ganglion, andnuclear cell layers in the central retina (b,h). Loss of nerve fibers isconfirmed by Tuj 1 staining (c,i). Unlike littermate controls (d),Schlemm's canal is absent in A1A2 cKO mice (j). Anterior chamberdrainage is further diminished by a loss of Lyve-1 positive lymphaticcapillaries in the corneal limbus (e,k). Lymphatic vasculature ispresent in non-ocular tissues, but exhibits disturbed patterning asshown here in the dermis of the ear (f,l). Mice lacking Angpt1 or Angpt2individually develop lymphatics in the corneal limbus (m,n). Compared tocontrols, A1A2 cKO mice have fewer nuclei in the retinal ganglion celllayer (o). GCL, ganglion cell layer, INL, inner nuclear layer, ONL,outer nuclear layer, RPE, retinal pigment epithelium, V, blood vessel,SC, Schlemm's canal. Red arrowheads indicate thickness of the nervefiber layer. Scale bars indicate 200 μm in all panels except f and 1where they represent 1 mm. **P<0.01.

FIG. 4 shows Foxc2 regulates Tie2 expression in lymphatic endothelium.(a) Tie2 mRNA expression was measured by real-time PCR in lymphaticendothelial cells isolated from E15.5 Foxc2^(Flox/Flox) (Ctrl) orFoxc2^(flox/flox);Prox1CreERT2 (Foxc2 cKO) mouse embryos. N=6 controland 6 Foxc2 cKO embryos. (b) Human dermal lymphatic endothelial cellswere cultured in the presence of specific siRNAs targeting Foxc1, Foxc2or a scrambled siRNA control. Compared to scrambled control siRNA(lane 1) or Foxc1 siRNA (lane 2), siRNA targeting Foxc2 (lane 3) causeda reduction in Tie2 protein expression. Error bars indicate s.e.m.*P<0.05 determined by two-tailed t test.

FIG. 5 shows lymphatic vessels present in extra-ocular tissues ofA1A2Flox^(WBΔE16.5) mice. Confocal microscopy was used to comparepatterning of LYVE-1 positive lymphatic capillaries in whole mount eartissue from (a) control and (b) A1A2Flox^(WBΔE16.5) mice.

FIG. 6 shows the strategy used to generate the whole-body, induciblecombined Angpt1/Angpt2 knockout mouse model (A1A2Flox^(WB) mice). (a)The conditional Angpt2 knockout construct contains loxp sites flankingexon 4 and was used to target mouse embryonic stem cells. Chimericfounders were crossed to mice expressing FlpE recombinase to excise theneomycin selection cassette and produce Angpt2Flox(Neo out) mice. (b)Angpt2Flox(Neo out) mice were bred with an inducible, whole body Angpt1knockout model to generate the A1A2Flox^(WB) mice described in thisstudy. (c) The ROSA26-rtTA-TetOnCre system allows robust, whole-bodydeletion of Angpt1 and Angpt2 upon induction with doxycycline.

FIG. 7 shows Lyve-1-positive lymphatic (a,b) and CD31-positive vascular(c,d) capillaries develop in the corneal limbus of mice lacking eitherAngpt1 or Angpt2 alone. These mice do not develop the buphthalmosphenotype observed in double knockout A1A2Flox^(WBΔE16.5) mice.

FIG. 8 shows a control kidney cross-section at left and on the right across-section of a A1A2Flox^(WBΔE16.5) mouse kidney showing dramaticcysts.

DESCRIPTION

Embodiments of the invention are discussed in detail below. Indescribing embodiments, specific terminology is employed for the sake ofclarity. However, the invention is not intended to be limited to thespecific terminology so selected. While specific exemplary embodimentsare discussed, it should be understood that this is done forillustration purposes only. A person skilled in the relevant art willrecognize that other components and configurations can be used withoutparting from the spirit and scope of the invention. All references citedherein are incorporated by reference as if each had been individuallyincorporated.

Angiopoeitin2 (“Angpt2”) and the orphan receptor Tie1 are known to beinvolved in lymphatic development, but until now, roles for Tie2 and itscanonical ligand Angpt1 have not been described. Surprisingly, whileAngiopoietin (“Angpt1”) knock out (“KO”) mice die between E9.5 and E12.5due to major cardiovascular defects, conditional deletion of Angpt1after E13.5 produces no overt vascular phenotypes in adult mice.

However, while the blood vascular role of the pathway has beenextensively studied, the function of angiopoietins in lymphaticendothelium is uncertain.

To determine if there is unrecognized cooperation between Angpt1 andAngpt2 in vivo, which might provide compensation in mice lacking Angpt1,a conditional Angpt2 knockout allele was generated and produced micelacking both major Angiopoietin ligands (A1A2Flox^(WB)). Strikingly,simultaneous deletion of both ligands at midgestation phenocopiesdeletion of Tie2—demonstrating cooperativity between Angpt1 and Angpt2in vivo. Whole-body deletion of the Tie2 receptor or both Angpt1 andAngpt2 at E12.5 leads to gross subcutaneous edema in embryos, withassociated patterning defects in dermal lymphatic vessels. While Angpt2knockout mice exhibit lymphatic valve defects and mesenteric lymphaticabnormalities resulting in chylous ascites (2), they do not develop theembryonic edema observed in A1A2Flox^(WB) or Tie2 conditional KO mice,suggesting a compensatory role for Angpt1 in lymphatic development.

Deletion of the Tie2/Tek ligands angiopoietin 1 and 2 in mice(A1A2Flox^(WB) mice) results in high TOP, bupthalmos and classicfeatures of glaucoma including retinal ganglion degeneration and visionloss. Eyes from A1A2Flox^(WB) mice lack drainage pathways includingSchlemm's canal and lymphatic capillaries in the corneal limbus, whichshare expression of Prox1, VEGFR3, and the Foxc transcription factorsthat are linked to glaucoma and lymphatic disorders in patients. Incontrast to blood endothelium where Angpt2 is an antagonist of Angpt1,it is shown that both ligands cooperate to regulate Tie2 in thelymphatic network of the eye. While A1A2Flox^(WB) mice develop high IOPand glaucoma, expression of Angpt1 or Angpt2 alone is sufficient forocular drainage. Furthermore, it is demonstrated that loss of Foxc2 fromlymphatics results in Tie2 downregulation, suggesting a mechanism forocular defects in patients with Foxc mutations. These data reveal a newpathogenetic and molecular basis for glaucoma, demonstrating theimportance of angiopoietin ligand cooperation in lymphatic endothelium.

To investigate combined role(s) of Angiopoietin 1 and 2 in adult mice,both ligands were deleted at E16.5. A1A2Flox^(WBΔE16.5) mice are born innormal Mendelian numbers and are indistinguishable from controllittermates during the first 3 weeks of life. However, eyes of mutantanimals begin to protrude noticeably 21-28 days after birth. As shown inFIGS. 1 a to d, bilateral buphthalmos worsens with age, and by 8 weeks,mice have difficulty closing their eyelids. Gross examination revealscorneal enlargement and increased anterior chamber depth as is shown inFIGS. 1 e to h. Pupils of A1A2Flox^(WB) mice appear fully dilated (FIG.2), suggesting that anterior segment enlargement is due to highintraocular pressure (IOP)(9). IOP was measured at 10 weeks using arebound tonometer(10). While control animals had intraocular pressurereadings within the normal range, IOP of mutant littermates wassignificantly elevated, ranging from 24-52 mmHg (FIG. 1 i). Using anoptomotor response test(11, 12) A1A2Flox^(WBΔE16.5) mice were found tohave severely impaired vision, with visual acuity <0.042 cycles/degreein all animals examined (FIG. 1 j). Histological analysis of eyesections revealed excavation of the optic nerve head (FIG. 3 a,g) andother characteristic features of glaucomatous eye disease. Mutantretinas have reductions in thickness of retinal cell layers includingthe ganglion and inner nuclear layers and loss of the nerve fiber layer(FIG. 3 b,c,h,i,o; FIGS. 3,4). Unlike human glaucoma, which is rarelyassociated with photoreceptor loss (13), A1A2Flox^(WBΔE16.5) mice showthinning of the outer nuclear layer which worsens toward the retinalperiphery. This outer retina damage is similar to that described inlaser-induced models of high-IOP mouse glaucoma, suggesting thepossibility of pressure-related or ischemic effects (14). While loss ofphotoreceptors may be partially responsible for the vision lossobserved, this degree of photoreceptor atrophy is not sufficient toexplain the dramatic decrease in visual acuity seen in A1A2Flox cKOmice. Taken together, these data confirm that A1A2Flox^(WB) micerepresent a new model of glaucoma.

To determine the cause of high intraocular pressure and glaucoma inA1A2Flox^(WBΔE16.5) mice, the aqueous humor drainage system of the eyewas studied. While the trabecular meshwork and ciliary body wereindistinguishable between knockouts and controls, Schlemm's canal (“SC”)was absent in 8/8 A1A2Flox^(WBΔE16.5) eyes examined (FIG. 3 e,f). SC waspresent in all control littermates. Although SC is a major route ofaqueous humor drainage from the iridocorneal angle, defects in SCformation have not been reported to raise IOP in mice. Transgenic micehaploin sufficient for the transcription factor Foxc1 have been reportedto exhibit small or absent SC, yet do not develop high IOP (15).Previous studies of aqueous humor dynamics in mice have suggested thatonly 20% of total fluid drainage is carried out via SC, suggesting thatalternate drainage routes including the uveoscleral and lymphatic routesmay be able to increase flow in compensation for defects in SC (16).

To better understand alternate drainage pathways of the anteriorchamber, lymphatic and vascular capillaries in the corneal limbus werestudied. Vessels were examined by confocal microscopy of flat-mountedeyes, which revealed complete absence of Lyve-1 positive lymphaticendothelium in the limbus of A1A2Flox^(WBΔE16.5) mice (FIG. 3 e,k). Bycontrast, CD31-positive blood vasculature is present, but exhibitsdisturbed patterning, with some capillary loops extending into thecornea. It is unclear if this aberrant vascular morphology is a directeffect of Angpt1 and Angpt2 deletion, or a response to loss of lymphaticdrainage and/or stretching of the cornea. Mice lacking Angpt1 or Angpt2alone develop normal lymphatic vasculature in the corneal limbus (FIG. 3m,n, FIG. 7), suggesting the presence of inter-ligand compensation inthe lyphatic endothelium. Corneal neovascularization and glaucoma havebeen described in patients with Axenfeld-Rieger syndrome due tomutations in Foxc1, and Foxc1 haploinsufficient mice exhibit defects inthe anterior chamber and Schlemm's canal, suggesting a link to thismolecular pathway(15). Intriguingly, the downstream targets of Foxc1responsible for these anterior chamber defects have not been elucidated.Given the matching expression pattern of Foxc1 and 2 with Tie2 andAngpt2 in lymphatics, as well as the overlapping phenotypes (18, 19),Foxc1 or Foxc2 may be responsible for regulating expression of Tie2 orangiopoietin ligands in lymphatic endothelium. De Val and colleagueshave reported the presence of a FOX:ETS transcriptional enhancersequence in the Tie2 promoter region, and demonstrated Foxc2-mediatedenhancer activation using an in vitro reporter system—further suggestinga link between these pathways(20). The possibility of Foxc-mediated Tie2regulation was investigated using complimentary in vivo and in vitrosystems, at the protein and mRNA level. Lymphatic endothelial cells wereisolated from lymphatic-specific Foxc2 knockout(Foxc2^(flox/flox);Prox1CreERT2 (21)) embryos at embryonic day 15.5using fluorescent activated cell sorting (FACS). mRNA was isolated, andreal-time PCR revealed a 74.5% reduction (N=6 animals per group,P=0.015) in Tie2 mRNA expression relative to controls (FIG. 4 a). Thisresult was verified at the protein level using an in vitro siRNA systemin human dermal lymphatic endothelial cells. Using this system, siRNAtargeting of Foxc2 was found to cause marked reduction in Tie2 proteinexpression compared to Foxc1 or scrambled siRNAs (FIG. 4 b).

These results suggest a mechanism for lymphatic phenotypes in patientswith Foxc2 mutations or in Foxc2 knockout mice, and provide additionalevidence of a connection between Foxc and angiopoietin/Tie2 molecularpathways.

Surprisingly, Lyve-1 positive lymphatic vessels are present innon-ocular tissues of A1A2Flox^(WBΔE16.5) mice, although patterning insome organs is abnormal. In the dermis of the ear, lymphatic vesselsappear sparse with variable vessel diameter and abnormal branching (FIG.5 a,b) similar to that described in Angpt2-null mice (19). It ispossible that the specialized lymphatic vessels of the anterior chamberare more dependent on Angpt-Tie2 signaling than other lymphaticendothelia, suggesting that, like vascular endothelia, lymphaticcapillaries from different organs are heterogeneous with uniquefunctions and regulatory mechanisms. Indeed, Schlemm's canal has beendescribed as a hybrid vessel with features of both blood and lymphaticendothelium, expressing blood endothelial markers CD34 and E-Selectin,and a subset of lymphatic markers including Prox1 and VegfR3 but notPodoplanin (22-24).

The cardiovascular phenotypes reported in Angpt1 and Tie2 knockoutmodels highlight the important function of these molecules in cardiacdevelopment and angiogenesis. In older animals, the data suggestAngiopoietin-Tie2 signaling is less critical in quiescent bloodvasculature, but continues to play a major role in lymphaticendothelium. At the outset, it was hypothesized that A1A2Flox^(WB) micewould develop severe vascular defects, revealing a compensatory role forAngpt2 in the blood vasculature of mice lacking Angpt1. Instead, it wasobserved that lymphatic defects reported in Angpt2-null mice areenhanced by the additional loss of Angpt1, demonstrating cooperationbetween ligands in lymphatic endothelium.

While the overall mechanism responsible for human glaucoma remainsobscure, the most important risk factor is elevated intraocular pressure(25). IOP is determined by the relative rates of aqueous humor drainageand formation, and the majority of glaucoma treatment has focused onlowering TOP by targeting these systems (26). Aqueous humor is thoughtto drain through two major pathways, the trabecular meshwork leading toSC, and the uveoscleral pathway. In humans, studies have estimated thatthe uveoscleral pathway accounts for 46-54% of total outflow, with theremainder carried through SC (27). The contribution of lymphatic vesselsto each pathway has not been reported, but recent studies in sheep havesuggested they do play an important role in allowing fluid to escapefrom the anterior chamber (28). As increased TOP observed inA1A2Flox^(WBΔE16.5) mice is more severe than that of other models withabnormal SC, it was hypothesized that lymphatic vessels are essentialfor maintaining aqueous humor flow through the uveoscleral route.

It was shown that A1A2Flox^(WBΔE16.5) mice lack both Schlemm's canal andthe lymphatic capillaries of the corneal limbus, leading to a dramaticincrease in TOP and glaucoma. These data show that promotion oflymphangiogenesis with therapies such as Vegfc or Angpt-Tie2 agonistsprovides therapies for glaucoma.

It was also found that dramatic cysts are observed in mice lackingAngiopoietin 1 and 2 (FIG. 8 with A1A2Flox^(WBΔE16.5) kidney shown onright).

Given that the A1A2Flox^(WBΔE16.5) mice lack both Schlemm's canal andthe lymphatic capillaries of the corneal limbus and also have dramatickidney cysts, current activators of the Tie2 system will be helpful intreatments for people with open angle glaucoma and congenital glaucomaas well as those with cystic kidney disease. For patients with openangle glaucoma and congenital glaucoma Tie2 activation improves the sizeof Schlemm's canal and improvement of drainage, respectively. Apepto-mimic (peptide/nanomedicine) in an eye drop formulation is usefulfor treatment of open angle glaucoma and congenital glaucoma and thelevel of the resulting Tie2 activation is measurable by assessment ofphosphorylation of Tie2/Tek. In glaucoma these Tie2 receptor activatorscan improve ocular lymphatic drainage, and specifically improve drainagethrough Schlemm's canal and corneal limbal lymphatics, through topicaldelivery of these Tie2 receptor agonists delivered to the eye.

Loss of Angpt1 and Angpt2 concurrently or their canonical receptorTie2/Tek results in dramatic cystic formation in the kidney. Activationof Tie2 will reverse these phenotypes. Delivery of these Tie2 receptoractivators is by subcutaneous injection for cystic kidney disease.

Currently available Tie2 receptor activators are: angiopoietin 1recombinant proteins, peptides, VE-PTP phosphatase inhibitors, andTie2-peptomimetics. However, it will be understood that new forms ofTie2 receptor activators as developed are also applicable to the presentinvention.

Examples Supporting FIGS. 1, 3, 4

Study Approval

All animal experiments were approved by the Animal Care Committees atthe Center for Comparative Medicine of Northwestern University(Evanston, Ill., USA).

Mice and Breeding

To create the doxycycline-inducible, whole-body Angpt1; Angpt2 doubleknockout mouse used in this study, a new Angpt2Flox mouse was generatedwhich was crossed onto the ROSA-rtTA;Tet-On-Cre, whole-body Angpt1knockout line previously developed in our laboratory (3). Whole-body Crerecombinase expression was induced by treating pregnant dams withdoxycycline at embryonic day 16.5 (E16.5) to generateA1A2Flox^(WBΔE16.5) pups.

Live-Animal Studies

Intraocular pressure was measured at 8 weeks of age using a Tonolabrebound tonometer (iCare, Vantaa, Finland) as previously described 13.Visual acuity was estimated using an Optomotor response test14,15. Theoptomotor system used for these studies provides a maximum grating sizeof 0.042 cycles per degree, and mice were scored as “no response” ifthey were unable to respond to this stimulus.

Tissue Collection and Histology

A1A2Flox^(WB) mice induced at E16.5 and littermate controls were aged 8weeks before tissue harvest for histological studies. Whole eyes wereperfusion-fixed (2.5% Gluteraldehyde, 2% Formaldehyde in 0.1M phosphatebuffer pH 7.4), embedded in Epon 812 and sectioned using anultramicrotome. Sections were stained with Toluine blue and imaged on acompound microscope. Optic nerve sections were embedded in paraffin,sectioned and stained using haematoxylin and eosin.

Immunofluorescence

Eyes dissected from A1A2Flox^(WBΔE16.5) mice and littermate controlswere bisected and immersion fixed (4% Formaldehyde, 0.1M phosphatebuffer pH 7.4). After fixation, retinas and optic nerves were removedand hemispheres stained as whole-mounts.

Fluorescent Activated Cell Sorting (FACS) and Real-Time PCR of MouseLymphatic Endothelial Cells

Cells isolated from E15.5 control (Foxc2^(flox/flox)) andlymphatic-specific Foxc2 knockout (Foxc2^(flox/flox);Prox1CreERT2) mouseembryos were stained for Lyve-1 and CD31 and subjected to FACS aspreviously described (29). RNA was extracted from sorted lymphaticendothelial cells, cDNA was synthesized and qPCR was run using an ABI7500 real-time thermocycler.

Lymphatic Endothelial Cell Culture, siRNA Transfection, and Western Blot

Human dermal lymphatic endothelial cells were cultured with fetal bovineserum, antibiotics and other supplements. Cells were transfected withFoxc1, Foxc2 or control siRNAs and incubated for 48 h. At the end ofincubation, cells were harvested and lysates prepared. Proteins wereseparated by SDS-PAGE and blotted onto PVDF membranes for western blot.

Statistics and Figures

Throughout, indicated P-values were obtained using a two-tailedStudent's t-test. P-values are shown in figures using the followingnotation: *P<0.05, **P<0.01 and ***P<0.001.

Examples Supporting FIGS. 2, 5, 6 and 7 Mice and Breeding

All animal experiments were approved by the Animal Care Committees atthe Center for Comparative Medicine of Northwestern University (EvanstonIll., USA) and the Toronto Centre for Phenogenomics (Toronto, Ontario,Canada). Animals housed at either center were allowed unrestrictedaccess to standard rodent chow (Harlan #7912) and water. To create theconditional Angpt1, Angpt2 double knockout mouse line used in thisstudy, a new Angpt2Flox mouse was generated which was crossed onto theinducible, whole-body Angpt1 knockout line previously developed in ourlaboratory (3). An Angpt2Flox targeting construct was obtained from theSanger Institute knockout mouse project (clone #PRPGS00100_B_CO2) andused to target mouse embryonic stem (ES) cells by homologousrecombination. This construct introduces loxp recombination sitesflanking exon 4 of the Angpt2 gene, as well as a neomycin-resistancecassette flanked by frt recombination sites for flpe recombinase (FIG.6a ). Blastocyst morula aggregation was performed at the Toronto Centrefor Phenogenomics (Toronto, Canada), and chimeras were crossed towild-type ICR mice. F1 animals were screened by PCR and Southern blot,and those positive for the Angpt1Flox(Neo in) allele were crossed tomice expressing FlpE recombinase (B6;SJL-Tg(ACTFLPe)9205Dym/J, TheJackson laboratory, Bar Harbor, Me.) to excise the Neomycin selectioncassette used in ES cell cloning. FlpE excision was verified by Southernblot, and Angpt2Flox(Neo out) mice were selected for all subsequentbreeding. Newly created Angpt2Flox mice were crossed onto thewhole-body, inducible Angpt1Flox/ROSA26-rtTA/TetOnCre line previouslygenerated in our laboratory (3) to createAngpt1/Angpt2/ROSA26-rtTA/TetOnCre line (A1A2FloxWB mice). Angpt1 andAngpt2 deletion was induced by addition of 0.5% Doxycycline to thedrinking water of pregnant dams at day 16.5 of gestation to generateA1A2Flox^(WB.E16.5) offspring. Knockout mice were genotyped by PCR,using the following primers: Angpt1Flox, Forward5′-CAATGCCAGAGGTTCTTGTGAA-3′; Reverse 5′-TCAAAGCAACATATCATGTGCA-3′ (WT:233 bp product, Angpt1Flox: 328 bp), Angpt1Delete, Forward5′-CAATGCCAGAGGTTCTTGTGAA-3′; Reverse 5′-TGTGAGCAAAACCCCTTTC-3′ (431 bpproduct), Angpt2Flox, Forward 5′-GGGAAACCTCAACACTCCAA-3′; Reverse5′-ACACCGGCCTCTAGACACAC-3′ (WT: 224 bp product, Angpt2Flox: 258 bp) andAngpt2Delete, Forward 5′-AAGGCGCATAACGATACCAC-3′; Reverse5′-TGAGAACTCTGCAGCCTTGA-3′ (Angpt2Flox: 1,372 bp product, Angpt2Delete:426 bp).

Live-Animal Studies

Intraocular pressure was measured at 8 weeks of age using a Tonolabrebound tonometer (iCare, Vantaa, Finland). Mice were restrained in asoft plastic cone and ocular pressure for each eye was averaged fromthree sets of six recordings. Each mouse was measured on two subsequentdays and the results were averaged to obtain the reported IOP values.Visual acuity was measured using an Optomotor response test aspreviously described (10, 12). Briefly, animals were placed on anelevated platform surrounded by four LCD monitors. Monitors displayedvertical gratings as moving visual stimuli. Mice were observed and headmovement following the direction of moving gratings was scored aspositive optomotor response. Spatial frequency of the moving gratingswas gradually increased, and visual acuity was scored as the highestfrequency triggering a response. Optomotor tests on each mouse wererepeated on consecutive days, and results for each mouse were averagedto obtain the final visual acuity value. The optomotor response systemused for these studies provides a maximum grating size of 0.042 cyclesper degree, and mice were scored as “no response” if they were unable torespond to this stimulus. For statistical comparison, animals with nooptomotor response were assigned a score of 0.042 c/d.

Tissue Collection and Histology

A1A2Flox^(WB) mice induced at E16.5 (A1A2Flox^(WB.E16.5)) and littermatecontrols were aged 8 weeks before tissue harvest for histologicalstudies. Mice were anesthetized by i.p. injection with 2, 2,2-Tribromoethanol. Tissues were cleared (PBS, 1 mg/ml lidocaine, 10 u/mlheparin) and fixed (2.5% Gluteraldehyde, 2% Formaldehyde in 0.1Mphosphate buffer pH 7.4) by cardiac perfusion. Eyes were dissected andpostfixed for an additional 8 hours at 4°. Whole eyes were embedded inEpon 812 and 0.5 μM sections were prepared. Sections were stained withToluine blue and imaged on a compound microscope. Histological studieswere performed using groups of 4 mice per genotype, and several sectionswere examined from each animal.

Immunofluorescence

A1A2Flox^(WB.E16.5) mice and littermate controls were sacrificedfollowing anesthesia by i.p. injection of 2, 2, 2-Tribromoethanol. Eyeswere dissected and immersion fixed (4% Formaldehyde, 0.1M phosphatebuffer pH 7.4). For flat mounts, fixed eyes were bisected sagittally,retinas and optic nerves were removed and hemispheres stained aswhole-mounts.

Samples were blocked overnight (5% Donkey serum, 0.5% Triton X100, TBSpH 7.4) before incubation with appropriate primary andfluorochrome-labeled secondary antibodies (Invitrogen, Carlsbad,Calif.). Stained tissues were flat-mounted and imaged using a Nikon C2+confocal microscope. Due to the thickness of whole-mount limbus tissue,30 μM Z-stacks were collected and maximum intensity projections wereused in the present manuscript. Primary antibodies used: goat anti-mouseLyve-1 (R&D Systems AF2125), rat anti-mouse CD31 (BD Pharmingen 550274).

Fluorescent Activated Cell Sorting (FACS) and Real-Time PCR of MouseLymphatic Endothelial Cells

Cells isolated from E15.5 control (Foxc2^(flox/flox)) andlymphatic-specific Foxc2 knockout (Foxc2^(flox/flox);Prox1CreERT2) mouseembryos were stained for Lyve-1 and CD31 and subjected to FACS aspreviously described (29). Briefly, E15.5 embryos were harvested inHank's balanced salt solution (HBSS, Sigma-Aldrich) and then chopped foran overnight digestion with collagenease I/II. The colleagenase-treatedcell suspension was incubated with RBC (Red blood cell) lysis buffer(StemCell Technologies, Vancouver, Canada). Following centrifugation,cell pellets were incubated with anti-Lyve-1 antibody (Abcam) for 20 minat 40 C. After washing with PBS, the cells were then stained with PEconjugated anti-CD31 antibody (BD Pharmingen) and Alexa 488-conjugateddonkey anti-rabbit secondary antibody (Invitrogen, Carlsbad, Calif.).After gauze filtration with a cell strainer (40 μm BD Biosciences) toobtain a single cell suspension, Lyve-1+/CD31+ LECs were sorted using BDFacsAria SORP 4-Laser. RNA was extracted from sorted LEC using TriZol(Invitrogen), cDNA was synthesized using the cDNA synthesis kit (Biorad)according to manufacturer's instructions. qPCR was run using an ABI 7500real-time thermocycler using the following primers: Tie2Fwd:5′-ACACTGTCCTCCCAACAGCTTCTT-3′, Tie2Rev: 5′-TGATTCGATTGCCATCCAACGCAC-3′,PpiaFwd: 5′-CAAATGCTGGACCAAACACA-3′, PpiaRev:5′-TGCCATCCAGCCATTCAGTC-3′.

Lymphatic Endothelial Cell Culture, siRNA Transfection, Protein ExtractPreparation and Western Blot

Human dermal lymphatic endothelial cells were cultured in EBM media(LONZA, Basel, Switzerland) with 10% fetal bovine serum, antibiotics andother supplements. The cells were transfected with Foxc1, Foxc2 orcontrol siRNAs using Lipofectamine RNAiMAX (Invitrogen) and incubatedfor 48 h. At the end of incubation, cells were harvested and whole celllysates were prepared using RIPA buffer. Protein lysates were separatedby SDS-PAGE and blotted onto PVDF membranes (Bio-Rad). Membranes wereblocked (TBS with 5% donkey serum, 2.5% BSA, 0.05% Tween-20) andincubated with appropriate primary and HRP-tagged secondary (JacksonImmunoresearch) antibodies. Signals were detected using ECL reagents(Bio-Rad). siRNAs: Scrambled (Qiagen, #1027281), Foxc1 (ThermoScientific, #L-009318-00-0005), Foxc2 (Thermo Scientific #ATTAA-004016).Primary antibodies: Rabbit anti-mouse Tie2 (Santa Cruz #SC-324, reportedby the supplier to recognize Tie2 of human and mouse origin), Rabbitanti-mouse βActin (Abcam #ab8227), Sheep anti-human FoxC2 (R&D Systems#AF5044).

Statistics and Figures

Throughout this study, plotted values are shown as means+/−standarderror (SEM). Statistical comparisons were performed using Graphpad Prism5.0 (Graphpad Software Inc. San Diego, Calif.). Indicated P-values wereobtained using a two-tailed Student's t-test unless otherwise noted inthe manuscript. P-values were indicated in figures using the followingnotation: *P<0.05, **P<0.01 and ***P<0.001. Figures were assembled usingGraphpad Prism 5.0, Photoshop CS5 (Adobe Software, San Jose Calif.) andInDesign CS5 (Adobe Software).

From the above detailed description of the invention, the operation andconstruction of same should be apparent. While there are herein shownand described example embodiments of the invention, it is neverthelessunderstood that various changes may be made with respect thereto withoutdeparting from the principle and scope of the invention as measured bythe following claims.

REFERENCES

Each of the following references below is hereby incorporated byreference in the entirety.

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What is claimed is:
 1. A method of treating a patient having open angleglaucoma, congenital glaucoma or cystic kidney disease, or for improvingocular lymphatic drainage in the patient comprising administering to thepatient a pharmaceutical composition comprising one or more agentscapable of TIE2 receptor activation, one or more of angiopoietin-1recombinant proteins, peptides, VE-PTP phosphatase inhibitors, and/orTie2-peptidomimetics. 2.-7. (canceled)
 8. A conditional Angiopoeitin 2knockout allele. 9.-10. (canceled)
 11. A method for treatment of cystickidney disease in a subject in need thereof, comprising administering tothe subject an effective dosage amount of a pharmaceutical compositioncomprising one or more Tie2 receptor activating agents.
 12. (canceled)